Search Results (468)

Mpox has become a significant health concern since the global outbreak that began in 2022. The aim of this study is to present the epidemiological situation of Mpox in Romania during 2022–2023 and to describe a severe case of Mpox in a patient who survived despite multiple co-pathologies. Forty-seven confirmed cases were reported at the national level, all in men, in 2022. The median age was 33 years. Twenty-six cases involved men who have sex with men (MSM), and twenty-three tested positive for HIV. We also describe a severe case involving a 34-year-old bisexual male with newly diagnosed AIDS who developed severe Mpox with persistent necrotic skin lesions, respiratory involvement, and multiple opportunistic infections: tuberculosis, pneumocystis pneumonia, syphilis, and oral candidiasis. The patient presented with fever, night sweats, weight loss, and dyspnea, with a single ulcerative facial lesion that later disseminated. Mpox infection was confirmed through PCR from skin lesion, serum, saliva, urine, rectal, nasal, and pharyngeal swab samples, with high viral loads persisting despite prolonged Tecovirimat therapy. The patient developed immune reconstitution inflammatory syndrome following the initiation of antiretroviral therapy. This case emphasizes the challenges of treating Mpox in immunocompromised patients. Full article

Background/Objectives: Limited robust data support the use of antibiotic combinations in the treatment of orthopedic infections. However, in certain situations, the combination of antibiotics seems to be beneficial. This review aims to outline the circumstances under which a combination of antibiotics may be utilized in the treatment of orthopedic infections. Methods: We reviewed the existing guidelines on orthopedic infections and focused on situations where antibiotic combinations are recommended or proposed optionally. We chose vitro and animal studies that provide evidence for the effectiveness of several widely recommended combinations. Results: The combinations serve multiple purposes: they provide empirical coverage while awaiting microbiological results, offer targeted treatment for difficult-to-treat infections, and facilitate oral treatment primarily for staphylococcal infections. The objectives include enhancing bacterial coverage against Gram-positive and Gram-negative bacteria, achieving synergistic effects with bactericidal agents, and reducing the risk of antibiotic resistance. The review outlines specific combinations for fracture-related infections, periprosthetic joint infections, spinal infections, and anterior cruciate ligament reconstruction infections, emphasizing the importance of tailoring antibiotic choices based on local epidemiology and patient history. The review also addresses potential drawbacks of combination therapy, such as toxicity, higher costs, and drug interactions, underscoring the complexity of managing orthopedic infections effectively. Conclusions: According to the guidelines, several different proposals are made, depending in part on the countries’ epidemiology. In a well-defined situation, various authors propose either monotherapy or a combination of antibiotics. When a combination is suggested, the choice of antibiotics is based on the expected effect: broadening the spectrum, enhancing bactericidal activity, achieving a synergistic effect, or reinforcing biofilm activity to optimize the treatment. Full article

Background and purpose: Indigenous people in the Brazilian Amazon are exposed to mercury by eating methylmercury-contaminated fish. The lack of information on the health effects of prolonged exposure to mercury hinders the implementation of mitigation programs offered by the Brazilian government. This article aims to evaluate the studies that have investigated mercury exposure in indigenous people living in the Brazilian Amazon. Methods: A scoping review of the literature was conducted from studies published between 1995 and 2024 in Portuguese, English, and Spanish that evaluated mercury (Hg) concentrations in hair samples in indigenous people from the Brazilian Amazon. Results: Using total mercury (TotalHg) values in hair samples, we analyzed exposure levels, prevalence, and toxic effects. We found 15 epidemiological studies with a cross-sectional design and sample sizes ranging from 31 to 910 participants. Four studies involved children and mothers, four of which were associated with clinical outcomes and three of which analyzed genetic polymorphism. Most of the communities evaluated had a high prevalence of mercury exposure, showing levels ranging from 0.8 to 83.89 µg/g, and the highest average TotalHg concentration was found among the Kayabi. Mercury was associated with hypertension, cognitive disorders, worse mental health indicators and central and peripheral neurological disorders. Conclusions: It is concluded that indigenous people in the Brazilian Amazon experience exposure levels that are causing damage to their health, and control measures must be adopted to prevent the situation from worsening. Full article

Background: Violence against healthcare professionals is a growing public health concern. In Spain, the National Observatory of Aggressions recorded 16,866 cases in 2024, marking a 103.06% increase since 2017. This phenomenon has intensified in recent years, with serious repercussions for both the physical and psychological well-being of healthcare workers, as well as for the quality of care provided. Objectives: This descriptive study examines the knowledge, perceptions, and experiences of workplace aggression among undergraduate students at the University School of Nursing of the Nuestra Señora de Candelaria University Hospital. Materials and Methods: A self-administered ad hoc questionnaire was distributed to 266 students across all academic years to assess their knowledge and to explore their perceptions and experiences of aggression witnessed or experienced during clinical placements. This study was guided by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: The findings revealed significant educational gaps among students regarding how to manage aggressive situations, as well as high levels of concern and an aggression exposure rate exceeding 30%. A statistically significant association was also observed in relation to the academic year. Conclusions: This study provides a foundation for the development of specific training programmes tailored to the needs identified and for enhancing occupational safety in healthcare settings. Full article

The most frequent form of ectopic pregnancy, known as tubal pregnancy, leads to a dangerous situation where the fertilized ovum implants inside a fallopian tube, which can result in tubal rupture and severe bleeding. The purpose of this narrative review is to evaluate all existing data regarding epidemiology, risk factors, pathophysiology, clinical presentation, diagnosis, and management of tubal ectopic pregnancy in order to provide a comprehensive understanding of this common yet difficult clinical condition. Prior ectopic pregnancy, together with tubal pathology and assisted reproduction, represent the main risk factors for this condition. The diagnosis relies on serial β-hCG tests combined with transvaginal ultrasonography, but laparoscopy serves as the diagnostic tool for cases with uncertain results. The treatment plan depends on the fallopian tube integrity, along with the patient’s hemodynamic condition. Patients with unruptured pregnancies who are hemodynamically stable receive methotrexate treatment as the preferred option, but surgical intervention with salpingectomy or salpingostomy becomes necessary in case of tubal rupture or when medical treatment fails. The development of laparoscopic procedures has led to better results and improved possibilities for fertility preservation. The psychological effects on patients require both counseling and follow-up care. Early detection, along with personalized management, helps decrease maternal complications and optimize reproductive outcomes. Full article

The increasing number of owned and stray dogs in large cities is becoming a pressing issue due to rising population densities, urban conditions, and poor control over animal reproduction. This situation poses serious epidemiological risks, as dogs can act as reservoirs and transmitters of infectious and parasitic diseases dangerous to humans. This study aimed to investigate the prevalence and carriage of infectious and parasitic diseases in stray dogs in the city of Uralsk as a factor of epidemiological risk. In 2024, 1213 stray dogs were captured from different city districts and examined at the veterinary clinic and laboratory of Zhangir Khan University. Biological samples (blood, urine, feces) from 10% of the animals were analyzed using molecular (PCR), serological (ELISA), and helminthological methods. Serological and molecular analyses revealed the widespread circulation of bacterial pathogens. Antibodies to additional bacterial agents, including Pasteurella multocida, Mycobacterium spp., Listeria monocytogenes, and Leptospira spp., were detected in the samples, indicating an unfavorable sanitary and epidemiological situation in the urban environment. An enzyme-linked immunosorbent assay (ELISA) identified antibodies against Toxocara canis in 50.9% of the dogs and against Echinococcus granulosus in 76.4%, reflecting both active and past infections. The polymerase chain reaction (PCR) results showed the presence of Brucella canis DNA in blood and urine samples, while antibodies to Brucella spp. were detected in 57.8% of the examined dogs, underscoring the significant zooanthroponotic importance of this pathogen and its potential threat to human health. Additionally, T. canis DNA was found in 39.2% of the samples and E. granulosus DNA in 16.6%. A helminthological examination using the Fülleborn method revealed a high rate of helminth infection: Ancylostoma caninum—35.3%, T. canis—32.3%, and Toxascaris leonina—29.4%. The obtained results highlight the significant role of stray dogs as epizootiological and epidemiological reservoirs of zooanthroponotic infections. This poses a serious threat to public health and necessitates the implementation of effective control and prevention measures for infectious and parasitic diseases within urban fauna. Full article

Fusarium head blight is one of the greatest threats to global wheat production. Despite the special attention paid by researchers to resistance genetics, the stability of resistance and the expression of its epidemiological relationships have not been tested in depth. As most studies only present data on visual symptoms, in this study, we present data from four experiments. Here, 15–40 genotypes were tested with four and eight isolates (inocula) in 3–4-year experiments, with 32, 24, 36, and 12 epidemic situations used to determine the disease index (DI), Fusarium-damaged kernels (FDKs), and DON. All genotypes were tested for stability by the variance across epidemics, and the b value of the linear function was considered. Both indices were suitable for measuring stability/instability, but the variance results were more closely correlated with the experimental data than the b value, known as the stability index (SI). The use of variance is recommended due to its simplicity and reliability. In the first test, the rate of maximum/minimum variance for DI, FDK, and DON differed 15-, 20-, and 120-fold, respectively. In the second test, the same rates were 200, 400, and over 4000, with the other tests exhibiting similar tendencies. The traits differ, the epidemics vary, and a dependence on resistance level can be proven. The genotype ranking varies strongly in different epidemics, with approximately 50% of the correlations between variety responses being insignificant. Therefore, many epidemics are needed to obtain a reliable picture of the adaptation ability of the resistance traits and their stability. Approximately 25% of the genotypes tested belong to the most stable group. About 35% were discarded, and in the 40% medium, we observed both highly unstable and moderately stable genotypes. Principal component analysis (PCA) of the three traits in the experiments showed a confirmatory, nearly uniform distribution of genotypes, with a different footprint or “identity card” present for each genotype. The genotypes for the traits belong to one or two groups, although sometimes individual genotypes seem to be independent. No strict rule was found. This underlines the necessity of considering the plant’s traits (Di, FDK, and DON) in resistance testing. Highly resistant winter wheat lines could also be bred with very low variance and SI values and very high stability (SI values lower than 0.3). Of the traits, DON is the most important. With this methodology, variety registration also becomes possible. The epidemiological aspect has a decisive role in resistance studies, and without identifying stability in FHB resistance, no food safety estimates can be made. Full article

This study examines the epidemiological situation of tuberculosis (TB) in the regions of the Republic of Kazakhstan over the past seven years (2018–2024), which cover the before-, during- and after-COVID-19 periods, with a focus on the risks of its emergence and spread. The analysis revealed that while TB incidence is declining, mortality remains high in the before- and during-COVID-19 periods, indicating a general decline in population health. The concentration of TB incidence in relation to geographic location was mainly in the northern, western and southern regions. Before COVID-19, TB incidence reached 48.2 cases and mortality reached a maximum of 2.4 cases per 100,000 people. In 2024, the incidence and mortality of tuberculosis significantly decreased to 33.5 (30.5%) and 1.0 (58.3%), respectively, reflecting an improvement in health indicators in the post-pandemic period. In the after-COVID-19 period, in regions with high unemployment, the incidence was higher than in the before- and during-COVID-19 periods. Nevertheless, it is important that the trend in tuberculosis incidence shows positive improvement after the COVID-19 period. In addition, a comparative analysis of tuberculosis incidence trends in different age groups and social factor groups shows that the adult population remains the most vulnerable category among the general population. The above-listed factors, as well as our analysis of tuberculosis incidence, shows that TB incidence does not always correlate with the level of vaccination in different regions of Kazakhstan, indicating a multifactorial influence on the tuberculosis epidemic. Full article

This study simulates the spread of epidemics on university campuses using a multilayer temporal network model combined with the SEIR (Susceptible–Exposed–Infectious–Recovered) transmission model. The proposed approach explicitly captures the time-varying contact patterns across four distinct layers (Rest, Dining, Activity, and Academic) to reflect realistic student mobility driven by class schedules and spatial constraints. It evaluates the impact of various intervention measures on epidemic spreading, including subnetwork closure and zoned management. Our analysis reveals that the Academic and Activity layers emerge as high-risk transmission hubs due to their dynamic, high-density contact structures. Intervention measures exhibit layer-dependent efficacy: zoned management is highly effective in high-contact subnetworks, its impact on low-contact subnetworks remains limited. Consequently, intervention measures must be dynamically adjusted based on the characteristics of each subnetwork and the epidemic situations, with higher participation rates enhancing the effectiveness of these measures. This work advances methodological innovation in temporal network epidemiology by bridging structural dynamics with SEIR processes, offering actionable insights for campus-level pandemic preparedness. The findings underscore the necessity of layer-aware policies to optimize resource allocation in complex, time-dependent contact systems. Full article

Bovine viral diarrhoea virus (BVDV) is the causative agent of bovine viral diarrhoea/mucocutaneous disease (BVD-MD). Its associated co-infections pose a threat to the cattle industry, which is becoming a key breakthrough in the global system of prevention in the cattle industry. In recent years, cases of co-infection have occurred and been reported from time to time, and this situation not only poses certain difficulties in controlling the outbreak and in treatment in the farming industry, but also poses considerable challenges in detection and diagnosis. In this review, by systematically integrating studies on BVDV co-infection, we firstly compared and analysed the characteristics of BVDV co-infection with viruses, bacteria and other pathogens in in vivo/in vitro models in terms of synergism, host immune response and epidemiological transmission. Then we systematically constructed a BVDV Co-infection Impact Map, which demonstrates a paradigm of pathogen–host–immune interactions in the transmission of BVDV and provides a theoretical framework for breaking through the current precision diagnostic strategies and showcasing the effectiveness of integrated prevention and control. Full article

Leptospirosis is a well-known disease that frequently occurs after floods. At the beginning of May 2024, a catastrophic flood occurred in the state of Rio Grande do Sul, Brazil, affecting two million people and leading to a state of calamity. Given the State’s high pre-flood leptospirosis rates, the disease became a major concern for decision-makers. This study aimed to estimate the rise in leptospirosis cases after the flood, assess the changes in case patterns before and after the disaster, and document the response of the state health surveillance center to the outbreak. We estimated the increase during the flood period (May to July 2024) by comparing it with the same period in the previous year as baseline. During the first three months of the catastrophic event, 6273 suspected cases of leptospirosis were reported to the surveillance system, and 958 cases were confirmed. The number of confirmed cases during the flood was 10.3-fold higher than the baseline. Spearman’s rank-order correlation coefficient was 0.77 (p-value < 0.0001) for the association of Health Regions regarding the rank in incidence rates of confirmed cases in the flood period and the proportion of the population with households flooded. Thirty deaths (three females) were confirmed, a 6.0-fold rise compared with 2023. The state responders carried out many activities, including epidemiological surveillance and the dissemination of information. Among the challenges faced was the lack of evidence in the literature supporting recommendations for antibiotic chemoprophylaxis for rescue personnel. Another difficulty concerned performing gold-standard laboratory diagnostic tests to confirm the enormous number of suspected cases reported during this catastrophe. Despite implementing many actions to mitigate its impact, leptospirosis remained a major challenge during the event. These findings may provide valuable insights for decision-makers facing similar situations in massive climate disasters. Full article

In this paper, we analyze an optimal control problem with a mixed cost function, which combines a terminal cost at the final state and an integral term involving the state and control variables. The problem includes both state and control constraints, which adds complexity to the analysis. We establish a necessary optimality condition in the form of the maximum principle, where the adjoint equation is an integral equation involving the Riemann and Stieltjes integrals with respect to a Borel measure. Our approach is based on the Dubovitskii–Milyutin theory, which employs conic approximations to efficiently manage state constraints. To illustrate the applicability of our results, we consider two examples related to epidemiological models, specifically the SIR model. These examples demonstrate how the developed framework can inform optimal control strategies to mitigate disease spread. Furthermore, we explore the implications of our findings in broader contexts, emphasizing how mixed cost functions manifest in various applied settings. Incorporating state constraints requires advanced mathematical techniques, and our approach provides a structured way to address them. The integral nature of the adjoint equation highlights the role of measure-theoretic tools in optimal control. Through our examples, we demonstrate practical applications of the proposed methodology, reinforcing its usefulness in real-life situations. By extending the Dubovitskii–Milyutin framework, we contribute to a deeper understanding of constrained control problems and their solutions. Full article

Between 2006 and 2010, northwestern Europe experienced its first significant bluetongue virus (BTV) outbreak, driven by the spread of BTV-8, which had major repercussions on the European livestock sector. While BTV-3 was first identified in Europe in Italy in 2017, a new introduction of the virus was reported in 2023, in the Netherlands, and subsequently spread rapidly across the continent. A limited number of BTV-3 outbreaks were notified in Belgium in 2023, leading to the loss of its BTV-free status. In the following year, 2024, the virus spread throughout the country in a short time period. This study describes the impact of BTV-3 circulation in Belgium in 2024, detailing both its geographic spread and the associated increase in mortality, reduced births recorded, and decline in milk production among ruminants. Furthermore, preliminary results on the effectiveness of field vaccination and maternal immunity transfer are presented, as well as critical gaps that hinder the development of a robust, evidence-based management strategy. As the epidemiological situation is expected to become more complex in the future, due to the co-circulation of multiple BTV serotypes and other Culicoides-borne diseases, such as EHDV, effective collaboration and communication among stakeholders and international authorities will be crucial for implementing measures to mitigate the spread of these diseases. Full article

Clostridioides difficile Infection (CDI) continues to be a major cause of antibiotic-associated diarrhea and pseudomembranous colitis, fueled in large measure by virulence factors TcdA and TcdB. These giant glucosyltransferase toxins interfere with host cytoskeletal integrity and inflammatory signaling by inhibiting Rho GTPase; however, the detailed structural dynamics, receptor selectivity, and subcellular trafficking mechanisms remain in part unspecified. This review integrates recent insights from cryo-electron microscopy (cryo-EM) and X-ray crystallography to describe the quaternary architecture of TcdA/B, emphasizing conformational changes key to pore formation and endosomal escape. We also examine the genomic heterogeneity of hypervirulent C. difficile strains (e.g., ribotype 027), correlating toxin gene polymorphisms (e.g., tcdC mutations) with increased toxin production and virulence. Mechanistic explanations of toxin-driven inflammasome activation and epithelial barrier dysfunction are situated within host immune evasion mechanisms, including microbiota-derived bile acid regulation of toxin stability. Subsequent innovative therapeutic strategies, encompassing the utilization of engineered neutralizing antibodies that specifically target the autoprocessing domain alongside structure-guided small-molecule inhibitors, are subjected to a rigorous evaluation. By integrating structural biology, systems-level omics, and clinical epidemiology, this review establishes a comprehensive framework for understanding C. difficile toxin pathogenesis and guiding next-generation precision antimicrobials. Full article

This article is related to Sustainable Development Goal 3: Good Health and Well-Being and focuses on preparedness and response strategies, as well as resilient health systems capable of facing health crises. It presents the implementation and perceived effects of two student volunteering programs during the COVID-19 pandemic, underlining implications for medical education and healthcare. A cross-sectional study was performed using anonymous questionnaires among students from the University of Medicine and Pharmacy in Cluj-Napoca, Romania (April–May 2021); 51 student volunteers involved in activities from the Public Health Directorate of Cluj County (PHDCC) and 78 student volunteers involved in healthcare settings (HCSs) participated. The main reasons to become involved in volunteering activities with the PHDCC were the fact that students found the activity useful and necessary for the pandemic control (100%), an interest in helping other people (98.1%) and the need to be involved in the control of the pandemic (98.1%). Students participated in volunteering activities in hospitals, mainly to develop new medical knowledge and skills (94.8%) but also to apply the medical skills and knowledge they had (89.8%), because of the desire to help other people (88.4%) and the need to be involved in the control of the pandemic (87.1%). More than 90% of volunteers from the PHDCC reported an increase in knowledge regarding the transmission/prevention/clinical manifestations/diagnoses of SARS-CoV-2 and improved their abilities to conduct an epidemiological investigation, their communication skills and their capacity to develop and offer information/educational materials for different population groups and to make informed decisions with medical and legal consequences. Among volunteers in HCSs, the positive outcomes most frequently declared were the belief that this volunteering activity represents an important part of their future career, the opportunity to interact with people who were perceived as competent mentors and the fact that it helped them acquire new medical knowledge as well as made them feel useful. There were several differences noticed based on gender, previous volunteering experiences and volunteering position (student volunteer or student coordinator). Healthcare students might be a relevant resource in crisis situations. Full article